Page Heading Arial Black 26pt - Careerforcecircumstances. This adjustment takes time, and can see the person work through phases of shock, expecting to recover (denial), mourning,

US 27465 Level 3 Credits 6 Name

Workbook Contribute to therapeutic programmes and/or groups as a health assistant

Issue 1.0 – Jul 2012 27465 Contribute to therapeutic programmes and/or groups as a health assistant 2

US 27465 Level 3 Credits 6 Creative Commons

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Contents

Before you start ................................................................................................................ 4

Therapeutic programmes ................................................................................................. 7

Therapeutic groups ........................................................................................................ 10

Contribution of therapeutic programmes and groups to meeting a client’s goals............ 19

Precautions to reduce the risks to clients ....................................................................... 23

Contributing to therapeutic programmes and/or groups as a health assistant ................ 28


Before you start

Welcome to this workbook for: Contribute to therapeutic programmes and/or groups as a health assistant Unit Standard 27465. For this unit standard you will have: • This workbook. • A trainee assessment.

In this workbook you will learn more about: • Therapeutic programmes. • Therapeutic groups. • Precautions you can take to reduce the risks to clients when assisting with

therapeutic programmes and groups. • Contributing to therapeutic programmes and/or therapeutic groups as a health

assistant.

When you see a sticky note like this, it gives a tip or hint.

How to use this workbook • This is your workbook to keep – make it

your own by writing in it. • Use highlighters to identify important

ideas. • Do the learning activities included

throughout this workbook. Write your answers in the spaces provided.

• You might find it helpful to discuss your answers with colleagues or your supervisor.

• Finish this workbook before you start on the assessment.


Workbook activities

Stop – check what you know about this topic You will see this stop symbol in places where you are asked to stop and think about what you know and: • Record your current knowledge

or impressions. • Check your knowledge.

This stop provides a reference point to return to later. Stop activities have blue shading like this.

Rewind When you see this rewind symbol, go back to: • Think about what you know. • Check your knowledge.

This rewind gives you an opportunity to add to, change or confirm some of your initial thoughts and ideas. Rewind activities have green shading like this.

Learning activities You will come across learning activities as you work through this workbook. These activities help you understand and apply the information that you are learning about. Learning activities have yellow shading like this.


Before you go any further in this workbook, think about...

Therapeutic programmes and groups

What is the difference between a therapeutic programme and a therapeutic group?

How do therapeutic programmes and groups help clients to meet their goals?

What are two examples of risks that clients can face from participating in therapeutic programmes and groups?

1 2

What is your role as a health assistant when contributing to therapeutic programmes and groups?


Therapeutic programmes

What are therapeutic programmes? Many people living with and experiencing an injury, health and/or disability condition may require some interventions to help them: • Restore or maintain their functional ability. • Participate in activities of daily living and life roles. • Restore or maintain positive self image and feeling of worth. • Restore or maintain healthy and continuing relationships (companionship). • Encourage, support and promote independence. • Have physical, cognitive, mental and emotional wellbeing. • Have social involvement and a place to express and experience feelings and

emotions and receive emotional support. These interventions will have a therapeutic purpose. This purpose will be supported by an underlying set of rehabilitation principles that underpin the activities of the therapeutic programme and/or group that the person engages in. The Accident Compensation Corporation of New Zealand defines rehabilitation as:

“A process of active change and support to help a person with an injury to regain his or her health and independence, and therefore the ability to participate in his or her usual activities, as far as is practicable.”

Rehabilitation is concerned with the intrinsic worth and dignity of the client and with restoring them to a satisfying and purposeful life. It works to enable a person to live as independently as possible by working around, or compensating for, physical limitations. The client’s therapeutic programme will outline all the actions that will occur to support that client with their rehabilitation and to achieve their goals. This programme may have an individual component, and/or a group component. The individual component will be the tasks and activities that are chosen specifically for that client. The client completes these independently, with the delegating health professional or you in your role as the health assistant. This is the client’s therapeutic programme. The group component is when the client participates in a therapeutic programme with others as a group and not by themselves as an individual. Participating in the group allows the client to benefit from the social contact of the group and from interacting with others who understand their situation and feelings and who may be experiencing a similar situation.


Proprioception refers to the body’s ability to sense movement and position of the body or a limb through receptors in muscles, tendons, joints and the inner ear.

Types of therapeutic programmes Therapeutic programmes are structured interventions that have a specific focus in the treatment of a disability, injury or condition. An individualised therapeutic programme is designed to meet the unique health and/or disability needs of the client. The programme takes into account that client’s wishes, goals, health condition, personal knowledge about their condition and their own personal resources, for example, social, time and abilities. Remedial programmes aim to assist people who have injured their muscles, ligaments, tendons and other soft tisses. Restorative programmes are individualised programmes that address and remediate underlying impairments such as proprioceptive deficits and problems with balance, mobility, positioning and activities of daily living. The goal of restorative programmes is to restore function and independence where possible. Maintenance programmes are designed to maintain the person at the highest possible level by providing exercise, cognitive and activity programmes.


For a person you are currently supporting with a therapeutic programme, read each of the following questions and write your answers in the table below.

What is the type of therapeutic programme?

In your own words, describe the purpose of the programme. Consider whether the programme has a, remedial, restorative or maintenance focus (or a combination) and add this to your answer.

Why is this programme targeted towards this client?

What delegating health professional prepared this therapeutic programme for the client? • Occupational therapist • Physiotherapist • Speech language therapist • Other, for example, diversional therapist

What are the things the client does within this therapeutic programme? For example, exercises, socialising.

LEARNING ACTIVITY


Therapeutic groups

Therapeutic groups are where a number of clients with similar needs, who would benefit from the same therapeutic programme or activity, participate in the programme as a group and not by themselves. Therapeutic groups bring a range of individual clients together who may have similar experiences or goals. These groups allow clients to get the support of others and to feel they are not alone. When a client experiences an injury or a significant medical event such as a heart attack or stroke, they often have to make a significant adjustment to their changed circumstances. This adjustment takes time, and can see the person work through phases of shock, expecting to recover (denial), mourning, defensiveness and eventual acceptance. While undergoing this process, the client can also experience a range of emotions, from depression, denial, aggression and feeling dependent until adjustment/adaption is made. Therapeutic groups can play a vital role in supporting the client as they make this journey. The group can provide a place where the client can: • Express their problems, concerns or fears. • Feel as if they are with others who “understand”. • Be listened to. • Be supported. • Be motivated and encouraged. • Feel hope. • Help others.

It is these beneficial outcomes that can make participation in a group so valuable for a client. Therapeutic programmes and groups all have: • A purpose (what the programme seeks to achieve for clients). • A target client group (the clients the programme is aimed at). • An application (the type of programme and what happens as a part of the

programme).


Purpose of therapeutic programmes and groups The purpose of therapeutic programmes and groups is to enhance a client’s wellbeing and quality of life by maximising the client’s ability to perform roles, complete tasks and to minimise the effects of any “residual disability”.1 Therapeutic programmes often work to support the client’s physical functioning, with the purpose of: • Improving or maintaining the client’s physical function and ability by completing

enabling and purposeful activities. • Helping a client learn a new or different way of doing a task. • Using assistive equipment. • Reducing limitations and increasing participation and independence.

Therapeutic groups often support the client’s mental/emotional wellbeing. Therapeutic groups can help a client to: • Adjust to their changed circumstances (physical dysfunction). • Gain ideas, information and knowledge from others in the group. • Learn coping skills from other group members. • Gain motivation and support. • Share feelings, problems and perspectives with others and build a sense of

belonging by being able to identify with a certain group. • Have social interaction and relieve stress. • Enhance their quality of life.

1 Early, M. B. (Ed). (2006). Physical dysfunction practice skills for the occupational therapy assistant. St. Louis, Mo.: Mosby Elsevier, p. 22.


Target clients Therapeutic programmes are provided to a wide range of clients from young children to aged adults. They cover a range of client needs including: • Providing opportunities to practice life skills to those who have lost them. • Assisting recovery from accident, illness and/or surgery such as hip replacements,

brain injury, heart surgery, spinal injury or strokes. • Providing programmes to assist those with long standing health conditions and/or

disabilities, (such as MS, Parkinson’s disease, intellectual disabilities or amputations) to regain, maintain and/or improve function and achieve their goals.

Therapeutic programmes can be provided in a variety of settings such as: • Hospitals. • Rehabilitation centres. • Clients’ homes. • Community settings (including, but not limited to, local centres, schools and

preschools). • Rest homes/residential facilities.

Applications of therapeutic programmes and groups The application of therapeutic programmes and groups is the type of programme and how that programme or group is used to assist the client. There are different types of therapeutic programmes and groups that will each have a different purpose and way of achieving that purpose. Therapeutic programmes and groups can be found in: • Occupational therapy programmes. • Physiotherapy programmes, such as:

• Cardiopulmonary programmes. • Hydrotherapy programmes. • Programmes of stretches, passive movement and positioning.

• Speech language therapy programmes. • Structured and unstructured groups.


Occupational therapy programmes Occupational therapy aims to promote health through enabling people to participate in their chosen activities (occupations). Occupational therapy programmes help people to: • Have independent, productive and satisfying lives. • Develop, recover or maintain their ability to participate in, and perform, meaningful

and purposeful activities across the domains of self-care, work and/or recreation and leisure activities.

• Help compensate for any loss of function. • Improve physical, cognitive and social abilities. Occupational therapy programmes achieve these goals by collaborating with clients to: • Learn new ways of doing things following an illness or injury, for example a stroke

or limb amputation. • Use assistive devices such as raised toilet seats, eating utensils, walking frames,

tools with long handles, shower chairs etc. • Make changes or adaptions to their home, work or school environment to allow

them to continue to participate in their usual occupations. • Participate in leisure activities. • Develop ways to manage health and disability challenges to allow clients to

continue to live the life they want. • Develop new skills, abilities or interests. • Access supports available in the community. • Help them identify and acknowledge the skills they have and build confidence and

self esteem if necessary. • Link clients with others experiencing a similar situation.


Physiotherapy programmes and groups Physiotherapy programmes also work to help clients participate in life and in their communities in the fullest way possible. They seek to help the client maintain or regain their range of motion after injury/damage and/or impairment by using specialised knowledge of how the body works. These programmes work to: • Provide treatment and rehabilitation • Prevent injury • Promote health

Physiotherapy programmes include: • Cardio-pulmonary programmes • Hydrotherapy programmes • Programmes of stretches, passive movement and positioning

Cardiopulmonary programmes Cardiopulmonary programmes assist clients who have had cardiac (heart) or pulmonary (lung) surgery and/or those with ongoing cardiopulmonary conditions. These programmes aim to increase energy, physical strength, endurance and independence. They provide exercises, education and motivation to increase the client’s ability to be physically active. Hydrotherapy programmes In hydrotherapy programmes, exercises are done under water or in a pool. Hydrotherapy uses the physical qualities of water, such as buoyancy, resistance and temperature to support the client. The client is able to move more easily in water because the water’s buoyancy reduces the effects of gravity. Hydrotherapy is used with clients to: • Improve functional mobility. • Improve muscular and cardiopulmonary endurance. • Enhance wound healing and recovery from surgery and burns. • Aid rehabilitation, for example clients with spinal injuries. • Aid recovery from injuries, such as sports injuries or accidents. • Assist clients to manage the symptoms of health or disability conditions, for

example, asthma, osteoarthritis or rheumatoid arthritis.


Dysphasia (or

aphasia) is the partial

or total inability to

produce or understand

speech.

Dysphagia is difficulty

swallowing.

Programmes of stretches, passive movement and positioning Stretches are movements that lengthen muscles or muscle groups without causing tears or injuries. Passive movements are movements of the body by an outside force without voluntary action or resistance by the client. Positioning is about placing the body into postures and positions that are appropriate and supportive for the client. Therapeutic programmes of stretches, passive movement and positioning can be used to: • Prevent injury by warming up muscles. • Place the body in a position or shape that prevents or reduces pain, discomfort or

difficulty in functioning. • Facilitate movement within safe boundaries. • Improve mobility. • Improve balance and coordination. • Increase flexibility and range of motion. • Improve circulation. • Relieve stress. • Improve posture.

Speech language therapy programmes Speech language therapy programmes are used with children and adults to improve communication (language and social communication) and help treat swallowing difficulties. These programmes work with clients to improve: • Speech and language difficulties following a stroke, illness

or accident for example a traumatic brain injury. • Communicating when the client has a hearing loss. • Communicating, speaking and eating following a

laryngectomy (surgical removal of the larynx - voice box) • Stuttering/stammering. • Ability to swallow, such as from a health or disability condition, for example, multiple

sclerosis or a head and/or neck injury. • Communication when voice disorders are present (problems with the pitch,

loudness or quality of the voice), from a health or disability condition or injury. More information on each of these can be found at http://www.speechtherapy.org.nz/information-for-parents-and-families/resources-for-families

http://www.speechtherapy.org.nz/information-for-parents-and-families/resources-for-families

http://www.speechtherapy.org.nz/information-for-parents-and-families/resources-for-families


LEARNING ACTIVITY

Based on the people you are currently supporting with therapeutic groups, complete this table.

Programme Purpose


Structured and unstructured groups There are many different types of therapeutic groups. Groups can be structured or unstructured. Structured groups have a clear therapeutic goal and plan for each session, often with the same people attending regularly. Unstructured groups have a focus of participation in an activity for the sake of it and support people’s needs to be occupied in an interesting way, to be with other people and to develop leisure interests. Unstructured groups usually have a wide variety of people attending, and they do so for their own reasons. Both structured and unstructured groups have therapeutic value. Some examples of therapeutic groups follow.

Sit and be fit Sit and be fit is an award winning television/video exercise series. The classes are designed for older adults and those clients who are undergoing rehabilitation from an injury or illness. Sit and be fit allows exercises to be done on a chair to reduce physical strain and maximise physical benefit. Sit and be fit classes can help a client to: • Feel good about themselves, meet new people and have fun. • Maintain their physical condition, improve mobility and reduce the potential for falls. • Reduce stress and anxiety. • Improve their posture and control weight. • Have improved body functions such as sleep, digestion and heart and lung function.

Cardiac walking groups Cardiac walking groups assist people to recover/rehabilitate from a cardiac event or surgery. These groups have a variety of names and may also include other forms of gentle exercise such as yoga or Tai Chi. These groups are also a forum for members to learn more about staying well and to benefit from the social interaction with others. Other groups Other therapeutic groups may include activities such as newspaper reading, quizzes, card games, gardening, cooking, fishing and outings to places of interest.


LEARNING ACTIVITY

For a person you are currently supporting with a therapeutic group, read each of the following questions and write your answers in the table below.

What is the type of therapeutic group?

In your own words, describe the purpose of the group.

Why is this group targeted towards this client?

What delegating health professional recommended this therapeutic group for the client? • Occupational therapist • Physiotherapist • Speech language therapist • Other, for example, diversional therapist

What are the things the client does within this therapeutic group? What are the benefits the client gains from participating in the group?


Contribution of therapeutic programmes and groups to meeting a client’s goals

Each client will have goals that are important to them. These goals will relate to the client’s wellness and quality of life. For example: • Being able to complete activities of daily living or other tasks. • Gaining more independence in something they want to do. • Participating in life roles. • Gaining new roles or responsibilities. • Learning new skills. • Restoring and/or maintaining their function. • Rejoining (or recommencing) their social circle/network. • Participating in family, community and/or civic life.

Achieving these goals may involve achieving smaller sub-goals, such as: • Regaining the use of, or more use of, a limb. • Dressing independently. • Independently eating or feeding themselves.

As part of their support, the goals for each client will have been identified and incorporated into their service plan.

Service plans are the plans developed by service providers for clients receiving support (and may include their family/ whānau as appropriate).


To help achieve these goals, each client will have been assessed by the health care professionals involved in their care, such as a doctor or registered physiotherapist, occupational therapist, speech language therapist or multidisciplinary team. These assessments will have identifed:

• What the client can and can’t do. • How the client actually performs or completes the activity. • The client’s strengths, skills and abilities, such as speed, mobility, balance, strength

and flexibility. • Impairments to functioning that the client experiences, such as pain, limited range of

movement, incoordination, limited endurance etc. • Assistive equipment the client may benefit from.

The results of the assessment will inform the supports and services that are required. These are then recorded in the client’s service plan. As a part of meeting the client’s needs and fulfilling their personal goals, the client may participate in a therapeutic programme and/or group. It is important that you understand how the therapeutic programme and group that you are assisting in contributes to meeting each client’s goals. It is with this understanding that you can provide the right type of support. For example, for a client who has had cardiac surgery, a goal might be to participate in the life roles that they had before the health condition. They may participate in a therapeutic exercise programme to improve their strength, respiratory function and endurance. Increasing these abilities will then allow the client to engage in their life roles as a partner, parent and/or as a member of the workforce in the same way as they used to. Knowing how the therapeutic programme or group contributes to that client achieving their goals helps you to provide appropriate support. For example: • Supporting the client to follow the programme according to the instructions of the

appropriate health professional. • Supporting a client to safely use a piece of assistive equipment (as stated in the

client’s service plan). • Supporting the client to complete exercises or activities. • Reporting progress or barriers to progress to the appropriate health professional. • Providing encouragement or motivation as appropriate.

Your role is to work with and support the client to meet their goals under the supervision of the delegating health professional, such as the occupational therapist, physiotherapist or speech language therapist. Remember, you must be trained and deemed competent in the use of assistive equipment before using it.


LEARNING ACTIVITY

Choose a client you currently support. Consider how the client’s goals are being met by participating in their therapeutic programme.

What is the therapeutic programme that the client is participating in?

What are the client’s goals as stated in their service plan?

In your own words, describe how the client’s participation in the programme contributes towards them achieving their goals. It may be helpful to consider: • What the programme helps the client to do. • What other forms of support the client gets from the programme.


LEARNING ACTIVITY

Choose a client you currently support. Consider how the client’s goals are being met by participating in a therapeutic group.

What is the therapeutic group that the client is participating in?

What are the client’s goals as stated in their service plan?

In your own words, describe how the client’s participation in the group contributes towards them achieving their goals. It may be helpful to consider: • What the group helps the client to do. • What other forms of support the client gets from attending the group.


Precautions to reduce the risks to clients

Reducing risk and taking precautions Your organisation will have policies and procedures that you are expected to follow when assisting with therapeutic programmes and groups. These policies and procedures exist to keep you and the client safe. Risks for therapeutic programmes Any therapeutic programme will have risks for the client. The risk may be due to injury from: • Using equipment incorrectly. • Using faulty equipment. • The client not doing an exercise correctly. • Falls or over exertion by the client. • Slippery floors or a cluttered environment.

Other risks include: • Infections or cross contamination from hygiene and

infection control procedures not being correctly completed.

• Records not being properly kept or incorrect information being recorded.

• Not reporting incidents or accidents that occur during the session.

• The client’s goals not being met. • Breaches of the client’s privacy. • Loss of respect or dignity.


In your role, it is important that you are able to take precautions to reduce the risk to clients. These precautions include: • Ensuring that the client is always treated with respect and their dignity is maintained

at all times. • Ensuring the environment is free from potential hazards and/or identified hazards

have been dealt with appropriately (isolated or minimised). • Checking that the equipment is working correctly or is safe before using it with a

client, for example, checking the temperature of a heat pack to prevent the client being burned.

• Checking that you are using the equipment correctly with the client and checking with the appropriate health professional if you are not sure.

• Staying focused on the client and not allowing yourself to be distracted to ensure the client is not at risk of injury while you are with them.

• Observing the client to ensure they are performing the exercises correctly. • Following all hygiene and infection control procedures, such as washing your hands

and wearing gloves. • Ensuring only accurate data is recorded. Documenting client activities carried out

and how the client managed those activities in accordance with the policies and procedures of your organisation. This includes recording only the facts and not your opinions, for example, “the client seemed tired and weepy today”, not “the client is depressed”.

• Ensuring documentation is kept private, for example, not discussing the client in front of others.

• Ensuring that the client is encouraged and supported at all times. One of the most important skills in reducing risks is staying focused and attentive to both the client and the environment in which they are working. It is also your responsibility to notify the relevant health professional of any concerns you may have about carrying out the programme, for example: • Changes you have observed in the client. • Your own skill level.


Risks for therapeutic groups The same risks inherent in a therapeutic programme also apply to therapeutic groups but the risk factor may be increased due to the number of people involved and the fact that individual clients cannot be observed as closely. There is also the additional risk that the dynamics of the group may result in the purpose of the group or an individual’s goals not being met. Your organisation will have policies and procedures that you are expected to follow when assisting with therapeutic groups. These policies and procedures exist to keep everyone participating in the group safe and to ensure that the purpose of the group is maintained. It is important that you know and understand these policies and procedures. Risks to a client being able to achieve their goals include: • The client not feeling physically, emotionally or mentally safe. • Breaches of privacy or client confidentiality. • Records not being properly kept or incorrect information being recorded. • The same level of individualised attention not being provided. • Being new to the group and feeling insecure, self doubting, hesitant or reluctant to

participate.


In your role, it is important that you are able to take precautions to reduce these risks to clients. These precautions include: • Observing clients during the therapy session and reporting any observations you

make about clients that you feel it is appropriate for the health professional to know. • Checking that the client feels safe in the group and reporting any issues to the

health professional. • Ensuring a new client feels welcome and comfortable in the group. • Having an active working knowledge of cultural safety and the principles of cultural

competence. • Respecting the privacy of all clients, other support people and the health

professional. • Maintaining confidentiality by not discussing client information outside of the group

meeting with others who are not involved in that client’s care. • Ensuring only accurate data is recorded.

There are also risks that may mean the group is not able to meet its purpose. These risks include: • Confidentiality and privacy not being maintained. • Boundaries not being maintained. • Not following the instructions of the relevant health professional.

In your role, it is important that you are able to take precautions to reduce the risk of the clients not achieving their goals. These precautions include: • Maintaining confidentiality and privacy. • Maintaining boundaries, for example, not getting too involved or giving treatment

yourself. • Following the instructions of the relevant health professional and acting in

accordance with their wishes. • Knowing your role as a health assistant, that is, you are there to support rather than

participate.


LEARNING ACTIVITY

What are some of the risks to clients in the therapeutic programmes that you assist with? For each risk, identify at least one precaution that you take.

Risk to the client Precaution that I take


Contributing to therapeutic programmes and/or groups as a health assistant

As a health assistant, you will have an important role in contributing to the running of therapeutic programmes and groups. At all times, you will need to follow the instructions of the relevant health professional. Your contributions may include: • Welcoming clients and making them feel at ease. • Accompanying clients. • Preparing clients for treatment. • Preparing client files/records. • Assisting the health professional with the client’s treatment. • Carrying out planned therapy programmes following instructions from the relevant

health professional, such as: • Supervising existing exercise programmes. • Assisting with equipment for clients to continue their specified exercise

programmes. • Facilitating clients practising functional activities.

• Carrying out passive and assisted range of movement activities. • Applying orthoses (braces and splints) as instructed. • Helping clients to use assistive devices. • Preparing and applying equipment as instructed, such as ice packs, heated wheat

bags. • Setting up and cleaning up for therapeutic programmes and/or groups. • Reporting to the relevant health professional about each client. • Complying with all policies and procedures of your organisation as well as the

Health and Disability Sector Standards and legislation relating to: • Privacy. • Occupational health and safety, including:

• Infection control. • Identifying hazards.

• The Treaty of Waitangi. • Health and Disability Consumers’ Code of Rights.


LEARNING ACTIVITY

Think about a person you are currently supporting. Answer the following questions in the table below.

What is the programme and/or group?

Explain in your own words how you contribute to this programme/group.

Explain how you comply with the client’s service plan and your organisation’s policies and procedures.

How are you contributing to the health and wellbeing of the client?


Rewind to page 6...

For a client, what are the additional benefits of being part of a therapeutic group?

What are some of the precautions you can take to minimise the risks to clients when they are participating in therapeutic programmes or groups?

What are some of the policies and procedures of your organisation that relate to your role as a health assistant in contributing to therapeutic programmes and groups?


Congratulations! You have come to the end of the workbook. Please check over all the activities in this workbook to make sure you have completed them.

Your assessment is next You need to complete the trainee assessment successfully to be credited with this unit standard. Your assessor will sign you off once you have completed the assessment tasks satisfactorily.

Your assessor is able to give you a “Certificate of completion” for achieving this unit standard.

Acknowledgements

Careerforce would like to thank the people who have contributed their time and effort into creating this

workbook by: • Research and content validation. • Advice and expertise. • Testing the activities. • Sharing personal experiences. • Appearing in photographs.

Disclaimer: The images contained in these workbooks are visual illustrations only and are not

representative of actual events or personal circumstances.

Issue 1.0 – Jul 2012

Page Heading Arial Black 26pt - Careerforcecircumstances. This adjustment takes time, and can see the person work through phases of shock, expecting to recover (denial), mourning,

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